Scared Trait. Is It Helpful?

Can we stop it with the scare tactics, already, and maybe start giving people a little hope? Geez! No wonder a lot of people don’t want to deal with diabetes. With all of the dire information, predictions, and scare tactics being put forth—by people in the diabetes industry, yet—I’d guess folks figure that if they’re destined to be blind, bilateral amputees being wheeled to kidney dialysis three times a week anyway, they’re by golly going to have fun now!

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“OK, Jan,” you ask. “What got you started this time?”

It started with the American Diabetes Association’s (ADA) hot new ad campaign, which you can view here. Death. Amputation. Blindness. Photos of a coffin. A prosthesis. A card with braille.

The ADA wants money. Money for research. Money for prevention. Money for treatment. Not to mention adequate health coverage and the end of employment discrimination for people with diabetes. (I didn’t see the phrase “diabetes self-management education to help prevent,” etc., in the major talking points anywhere, but hey.)

Then, while surfing the ‘net, I went to www.myomnipod.com and read, “No painful injections…” (Psst! Injections are painful once in a blue moon, but generally unfelt. After all, you’re injecting a tiny amount of a nonviscous fluid through a needle less than the diameter of a human hair into fatty tissue, which is fairly bereft of nerve endings.)

The site, of course, is selling insulin pumps…er, pods. And you do have to get that insulin inside your body somehow, which it handles by saying that it has the “world’s fastest insertion, that’s also virtually pain-free.”

Insertion. Injection. Whatever. And is it really pain-free or only “virtually” pain-free? The point (pun unintended) is that promoting the notion that injections are painful is probably preventing many people from using insulin who really need it to help control their blood glucose, and scaring many more.

I understand that it’s a conundrum. “We have to point out that all these terrible things are happening so we can get funding for needed programs,” I can hear diabetes organizations saying. And, to be fair, some people who have diabetes believe that if we go around looking like we’re healthy all the time, the powers that be won’t take diabetes seriously.

But I believe that that message is also preventing people from getting the care they need to lower their risk of reaching those dire outcomes. Wouldn’t a message of hope be more likely to spur people to take better care of themselves?

I’m also a firm believer in the fact that many of today’s diabetes complications stem from yesterday’s lack of knowledge and tools. It’s been less than fifteen years since the release of the outcomes of the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), which showed that tighter control of blood glucose levels can lower the risk of diabetes complications; since the first nonsulfonylurea drugs were approved for Type 2 diabetes; since more physiological insulin analogs have become available; since the release of more user-friendly blood glucose meters; since the proliferation of insulin pumps for both types of diabetes; and probably much more. Frankly, things are changing so fast I’m having trouble keeping up with the onslaught.

I think another problem is that yesterday’s knowledge and tools are still being used by many of today’s health-care providers, but that’s a whole ‘nother subject. (You can see my previous post, “What Does Your Doc Know About Diabetes?”)

What if the message being given to people with diabetes was that, yes, this dirty, rotten, lousy condition can lead to all of those things, but you can reduce your risks by doing A, B, and C, and here’s how you can fit those things into your lifestyle?

I remember some LifeScan literature a few years ago that presented a problem and then gave a solution. Kind of along the lines of: “Tom felt tired in the afternoons, tested, and his blood glucose was 243. When he ate an apple at lunch instead of a megamuffin, he tested at 127 and felt much more energetic.”

A problem (high blood glucose), a solution (change one of your food choices), and an outcome (lower blood glucose). What a concept!

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Ephrenia

I have a problem understanding why we Americans view insulin use as a “last resort” treatment. Doctors will threaten patients with insulin if they don’t get their levels lower… like its a punishment!

I’ve read studies showing that patients who use insulin as a main-line treatment have fewer complications later in life.

I started on insulin right away. My fasting levels went from 300s to under 120 within a few days. My Dr offered to change me to oral meds. I refused. I like the immediate response I get from fast acting insulin when I “oops” and eat wrong. When I eat right, I only take the long-acting Basal shot once a day. I don’t want to switch to pills and risk losing the control I’ve gained by using insulin. I never wanted to choose to give myself shots. Never cared for needles. But it rarely hurts and offers me almost instant fixes when my levels go too high. To me, that’s better than taking a pill and worrying about it not coming down.

Ann

The scare tactics you mention are not only annoying — they are ineffective in the long run.

There are many studies in the research about behavior change that show that scaring people is NOT and effective way to produce long-lasting changes in behavior. Scare tactics alone immobilize people, or, as you suggest, actually increase the opposite behaviors.

But in a different context the scary facts can be helpful. It’s important to tell the truth BOTH about the awful things diabetes can produce, and also about how to avoid those awful outcomes. In other words, the scare tactics need to be linked to a way to get relief from fear. Scare/relief, or as you suggest, problem/solution — this communication pattern is one of the effective tools for long-term behavior change.

In this vein, I think the ADA ad would be more effective if it included more information about the progress in research and effectiveness of the programs that it’s promoting.

Chrissie in Belgium

Hi Jan,I have had for 45 years! I am very healthy, thin and fit. My control is MUCH better after getting an insulin pump. My only real complications are related to my eyes and this is basicly b/c I DID not receive the necessary laser treatments in time due to bad advice from an incompetent doctor a LONG time ago. Of course I am the sole person responsible for the management of my diabetes. I am not trying to shirk that responsibility. I have NOT always been a perfect diabetic. Diabetes is a HARD thing to manage day after day without vacation.

I agree with your opinion that we must encourage a positive attitude. Success leads to more success. Diabetese CAN be managed if we are given correct medical help and psychological support and encouragement. This is a big bill to fill, but our aim must be to work toward this goal. Diabetic blogs have helped me tremendously. Mine is at http://chrissieinbelgium.blogspot.com . We are a group of bloggers that try and HELP each other.

Mike Stoddard

AMEN!

And while we are at it it’s time to remind us all that it is our problem (mine for 46 years) and we have to be always on the alert for information in dealing with OUR diabetes. There is no free lunch but there is a lot of lunch out there. The price is to put in the effort and time to keep informed.

Cathy

Jan – I agree with your comments about the ADA ad. I was so taken by the ad and your comments about it that I sent an email of protest to the ADA. Good going! My comment to them was that if maybe they offered people some hope, we might try to take better care of ourselves.

Keep up the good work.

Cathy

Schadenfreudian

Come on. Seriously. There’s one thing Big Pharma has done to the viewing public: increase skepticism. Sadly, unless change comes via class action lawsuit or multiple deaths linked to a proprietary drug, few companies are going to invest any time into honestly informing the public. Scaring people works so much better, and we have a track record of scaring people to the point that we’ll sacrifice our precious liberties to prevent/avoid.

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